Payment Resources

September 19, 2020

Post-Payment Reporting Requirements

SEPTEMBER 14, 2020

On Wednesday, September 2nd, Center for Medicare Services (CMS) announced that they decided to reverse their position on the 59 modifier and code pairing restrictions and reinstate their use starting October 1st, 2020. Firm advocacy against this policy was helpful in reversing this same ruling in April, 2020, which the APTA and other healthcare associations played a large role in. Time appears to be repeating itself as CMS did not include these rulings in paperwork sent to healthcare associations across the country, leaving no time for edits, now a second time. For example, with this new policy, CMS will not pay for manual therapy (97140) when billed on the same day as an evaluation unless it is billed with the 59 modifier. This is clearly another barrier to practice and reimbursement and as with many CMS rulings, this poor healthcare policy is likely to reach outside of just CMS. 

For the APTA's full announcement and breakdown, please click here

For an infographic on how to properly use the 59 modifier, please click here

Interested in advocating for yourself and your patients, family and friends? Sign up for the APTA's Advocacy Network as an APTA member below.

OR, attend a Government Affairs Committee meeting and get plugged in!


JUNE 1, 2020

Win: CMS Says SNFs, Hospitals, HHAs, Rehab Agencies, Other Institutional Settings Can Bill Telehealth Outpatient Therapy Claims. The clarification from CMS applies to settings that use institutional claims such as UB-04.


Don't forget to use the CQ modifier if more than 10% of a service is furnished by a PTA.

TRICARE, the health insurance system used throughout the military, announced that it has officially revised its policy manual to recognize PTAs (and occupational therapy assistants) as authorized providers, outlining the rules and requirements governing assistant qualifications, scope of practice, supervision, and reimbursement.

Now it's up to TRICARE contractors to do the same within approximately 30 days.

As reported earlier, beginning with date of service on April 16, PTAs are recognized as authorized providers under TRICARE and thus eligible for reimbursement for covered services rendered to TRICARE beneficiaries.

Take note: The CQ modifier must be appended to the claim when more than 10% of an outpatient physical therapy service is furnished by the PTA. Check out APTA’s Quick Guide to Using the PTA Modifier.

The presence of the modifier shouldn't impact claims processing. However, if claims are denied, they may need to be resubmitted if the claims are sent to contractors before they fully implement the change.

IMPORTANT UPDATE: PT Compact Commission, APTA, FSBPT, and other Allies Successfully Resolve Medicare Issue

In late 2019, the Physical Therapy Compact Commission (PTCC) staff learned that an individual with a compact privilege was not allowed to enroll as a provider with Medicare in a member state and therefore could not make claims for services.

Since that time, the American Physical Therapy Association (APTA), PTCC, and FSBPT have been working closely to resolve the issue. The APTA has been instrumental in helping the PTCC determine the extent of the issue and coordinate a strategy to resolve it as quickly as possible. 

The PT Compact Commission recently received great news from the Centers for Medicare and Medicaid Services (CMS) officials that their general counsel determined that the compact privilege is considered a valid, full license for purposes of meeting federal licensure requirements. They are providing guidance to the Medicare Administrative Contractors (MACs) to accept compact privileges moving forward and to re-open any applications that were denied under this basis and continue processing. CMS is also drafting an MLN Matters article that will provide guidance about the Medicare enrollment process to PTs and PTAs practicing with compact privileges. Although there is not an exact timeline on the publication of the article and the notification to MACs is expected to take at least a few days, this is obviously fantastic news for PTs and PTAs!

The successful resolution of this important issue demonstrates the power of health care organizations working together. To receive more updates on the Medicare issue and other happenings at the PTCC be sure to sign up for their email distribution list

The APTA Payment section has information for the following topics:

More information on Federal Workers' Compensation:

More Information on Oregon Workers' Compensation:

Payment Forum